Provider Recoupments Manager
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Job Description
Provider Recoupments Manager leading operational execution of overpayment recoveries for Medicare Advantage business. Responsible for governance and execution of provider recoveries and collections through collaboration with multiple teams.
Responsibilities:
- Lead the Provider Recoupment function, overseeing the end-to-end lifecycle of overpayment recovery, from notification and validation to offset or collection.
- Oversee day-to-day operations for provider overpayments, overseeing the end-to-end lifecycle of overpayment recovery, from notification and validation to offset or collection as well as the processing of unsolicited refunds.
- Develop and execute a strategic plan to maximize recovery yield, reduce the aging of negative provider balances, and minimize "write-offs" due to uncollectible debt.
- Partner with Payment Integrity and Claims leadership to provide feedback loops on the root causes of overpayments, helping to prevent leakage before it occurs.
- Partner with Finance and Accounting to ensure accurate reconciliation of recouped funds, proper allocation to the general ledger, and precise financial reporting that is auditable.
- Collaborate with the Disputes and Appeals team to pause or adjust recoupment activities when a provider formally contests a finding.
- Develop clear provider communications and FAQ resources regarding the refund and offset process to reduce confusion and inbound call volume.
- Use data analytics to identify trends in unrecoverable balances and drive improvements in how we prioritize collection efforts.
- Lead continuous improvement initiatives to clear historical backlogs of negative balances and improve the speed of financial reconciliation.
Requirements:
- Experience in healthcare technology or finance
- Demonstrated ability to manage financial operations and drive collections while maintaining professional provider relationships.
- Experience with leveraging analytics and critical thinking to digest complex quantitative information, produce rigorous insights, design & implement operational models based on those insights, & develop appropriate analytics to measure success
- Bachelor’s degree required; focus in Finance, Healthcare Administration, or Business preferred.
Benefits:
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
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